Skip to main content
Top
Published in: Journal of Medical Case Reports 1/2011

Open Access 01-12-2011 | Case report

Recurrent, sequential, bilateral deep cerebellar hemorrhages: a case report

Authors: Osama SM Amin, Raz T Omer, Aso A Abdulla, Raz H Ahmed, Omed Ahmad, Soran Ahmad

Published in: Journal of Medical Case Reports | Issue 1/2011

Login to get access

Abstract

Introduction

Hypertensive intra-cerebral hemorrhage is usually a one-time event and recurrences are rare. Most recurrences develop as part of long-term failure of blood pressure control. The site of the re-bleed is usually limited to the basal ganglia and thalami.

Case presentation

We report the case of a 59-year-old hypertensive Caucasian woman who developed two sequential, right- and then left-sided, deep cerebellar hemorrhages. The second hemorrhage followed the first one by 57 days, at a time when her blood pressure was optimally controlled. In spite of these critical sites and short duration between the two bleeds, the patient achieved a relatively good functional recovery. Her brain magnetic resonance angiogram was unremarkable.

Conclusion

The development of recurrent hypertensive hemorrhage is rare and usually occurs within two years of the first bleed. To the best of our knowledge, this is the first reported case of bilateral, sequential, right- and then left-sided deep cerebellar hemorrhages. These hemorrhages were separated by eight weeks and the patient had a relatively good functional recovery. We believe that hypertension was the etiology behind these hemorrhages.
Appendix
Available only for authorised users
Literature
1.
go back to reference Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, Kistler JP, Pessin MS, Bleich HL: The Harvard Cooperative Stroke Registry: A prospective registry. Neurology. 1978, 28: 754-763.CrossRefPubMed Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, Kistler JP, Pessin MS, Bleich HL: The Harvard Cooperative Stroke Registry: A prospective registry. Neurology. 1978, 28: 754-763.CrossRefPubMed
2.
go back to reference Adams HP, Biller J: Hemorrhagic intracranial vascular disease. Clinical Neurology. Edited by: Joynt RJ, Griggs RC. 1993, Philadelphia: Lippincott-Raven Publishers, 2: 1-49. Adams HP, Biller J: Hemorrhagic intracranial vascular disease. Clinical Neurology. Edited by: Joynt RJ, Griggs RC. 1993, Philadelphia: Lippincott-Raven Publishers, 2: 1-49.
3.
go back to reference Biller J, Shah MV: Intracerebral hemorrhage. Conn's Current Therapy. Edited by: Rakel RE. 1997, Philadelphia: WB Saunders, 877-880. Biller J, Shah MV: Intracerebral hemorrhage. Conn's Current Therapy. Edited by: Rakel RE. 1997, Philadelphia: WB Saunders, 877-880.
4.
go back to reference Thrift AG, McNeil JJ, Forbes A, Donnan GA: Three important subgroups of hypertensive persons at greater risk of intracerebral hemorrhage. Melbourne Risk Factor Study Group. Hypertension. 1998, 31: 1223-1229.CrossRefPubMed Thrift AG, McNeil JJ, Forbes A, Donnan GA: Three important subgroups of hypertensive persons at greater risk of intracerebral hemorrhage. Melbourne Risk Factor Study Group. Hypertension. 1998, 31: 1223-1229.CrossRefPubMed
5.
go back to reference Challa V, Moody D, Bell M: The Charcot-Bouchard aneurysm controversy: impact of a new histologic technique. J Neuropathol Exp Neurol. 1992, 51: 264-271. 10.1097/00005072-199205000-00004.CrossRefPubMed Challa V, Moody D, Bell M: The Charcot-Bouchard aneurysm controversy: impact of a new histologic technique. J Neuropathol Exp Neurol. 1992, 51: 264-271. 10.1097/00005072-199205000-00004.CrossRefPubMed
6.
go back to reference Garcia JH, Ho K: Pathology of hypertensive arteriopathy. Neurosurg Clin N Am. 1992, 3: 497-507.PubMed Garcia JH, Ho K: Pathology of hypertensive arteriopathy. Neurosurg Clin N Am. 1992, 3: 497-507.PubMed
7.
go back to reference McCormick WF, Rosenfield DB: Massive brain hemorrhage: a review of 144 cases and an examination of their causes. Stroke. 1973, 4: 949-954.CrossRef McCormick WF, Rosenfield DB: Massive brain hemorrhage: a review of 144 cases and an examination of their causes. Stroke. 1973, 4: 949-954.CrossRef
8.
go back to reference Dinsdale HB: Spontaneous hemorrhage in the posterior fossa: A study of primary cerebellar and pontine hemorrhage with observations on the pathogenesis. Arch Neurol. 1964, 10: 200-217.CrossRefPubMed Dinsdale HB: Spontaneous hemorrhage in the posterior fossa: A study of primary cerebellar and pontine hemorrhage with observations on the pathogenesis. Arch Neurol. 1964, 10: 200-217.CrossRefPubMed
9.
go back to reference Freeman RE, Onofrio BM, Okazaki H, Dinapoli RP: Spontaneous intracerebellar hemorrhage. Neurology. 1973, 23: 84-90.CrossRefPubMed Freeman RE, Onofrio BM, Okazaki H, Dinapoli RP: Spontaneous intracerebellar hemorrhage. Neurology. 1973, 23: 84-90.CrossRefPubMed
11.
go back to reference Rey-Bellet J: Cerebellar hemorrhage: A clinicopathologic study. Neurology. 1960, 10: 217-222.CrossRef Rey-Bellet J: Cerebellar hemorrhage: A clinicopathologic study. Neurology. 1960, 10: 217-222.CrossRef
12.
go back to reference Brennan RW, Bergland RM: Acute cerebellar hemorrhage: Analysis of clinical findings and outcome in 12 cases. Neurology. 1977, 27: 527-532.CrossRefPubMed Brennan RW, Bergland RM: Acute cerebellar hemorrhage: Analysis of clinical findings and outcome in 12 cases. Neurology. 1977, 27: 527-532.CrossRefPubMed
13.
go back to reference Weisberg LA, Stazio A, Shamsnia M, Elliott D: Nontraumatic parenchymal brain hemorrhages. Medicine (Baltimore). 1990, 69: 277-295.CrossRef Weisberg LA, Stazio A, Shamsnia M, Elliott D: Nontraumatic parenchymal brain hemorrhages. Medicine (Baltimore). 1990, 69: 277-295.CrossRef
14.
go back to reference Kunitz SC, Gross CR, Heyman A, Kase CS, Mohr JP, Price TR, Wolf PA: The Pilot Stroke Data Bank: Definition, design and data. Stroke. 1984, 15: 740-746. 10.1161/01.STR.15.4.740.CrossRefPubMed Kunitz SC, Gross CR, Heyman A, Kase CS, Mohr JP, Price TR, Wolf PA: The Pilot Stroke Data Bank: Definition, design and data. Stroke. 1984, 15: 740-746. 10.1161/01.STR.15.4.740.CrossRefPubMed
15.
go back to reference Douglas MA, Haerer AF: Long-term prognosis of hypertensive intracerebral hemorrhage. Stroke. 1982, 13: 488-491. 10.1161/01.STR.13.4.488.CrossRefPubMed Douglas MA, Haerer AF: Long-term prognosis of hypertensive intracerebral hemorrhage. Stroke. 1982, 13: 488-491. 10.1161/01.STR.13.4.488.CrossRefPubMed
16.
go back to reference González-Duarte A, Cantú C, Ruiz-Sandoval JL, Barinagarrementeria F: Recurrent primary cerebral hemorrhage: Frequency, mechanisms, and prognosis. Stroke. 1998, 29: 1802-1805. 10.1161/01.STR.29.9.1802.CrossRefPubMed González-Duarte A, Cantú C, Ruiz-Sandoval JL, Barinagarrementeria F: Recurrent primary cerebral hemorrhage: Frequency, mechanisms, and prognosis. Stroke. 1998, 29: 1802-1805. 10.1161/01.STR.29.9.1802.CrossRefPubMed
17.
go back to reference Bae H, Jeong D, Doh J, Lee K, Yun I, Byun B: Recurrence of bleeding in patients with hypertensive intracerebral hemorrhage. Cerebrovasc Dis. 1999, 9: 102-108. 10.1159/000015906.CrossRefPubMed Bae H, Jeong D, Doh J, Lee K, Yun I, Byun B: Recurrence of bleeding in patients with hypertensive intracerebral hemorrhage. Cerebrovasc Dis. 1999, 9: 102-108. 10.1159/000015906.CrossRefPubMed
18.
go back to reference Dixon AA, Holness RO, Howes WJ, Garner JB: Spontaneous intracerebral hemorrhage: an analysis of factors affecting prognosis. Can J Neurol Sci. 1985, 12: 267-271.PubMed Dixon AA, Holness RO, Howes WJ, Garner JB: Spontaneous intracerebral hemorrhage: an analysis of factors affecting prognosis. Can J Neurol Sci. 1985, 12: 267-271.PubMed
19.
go back to reference Portenoy RK, Lipton RB, Berger AR, Lesser ML, Lantos G: Intracerebral hemorrhage: a model for the prediction of outcome. J Neurol Neurosurg Psychiatry. 1987, 50: 976-979. 10.1136/jnnp.50.8.976.CrossRefPubMedPubMedCentral Portenoy RK, Lipton RB, Berger AR, Lesser ML, Lantos G: Intracerebral hemorrhage: a model for the prediction of outcome. J Neurol Neurosurg Psychiatry. 1987, 50: 976-979. 10.1136/jnnp.50.8.976.CrossRefPubMedPubMedCentral
20.
21.
go back to reference Potter JF, Robinson TG, Ford GA, Mistri A, James M, Chernova J, Jagger C: Controlling hypertension and hypotension immediately post-stroke (CHHIPS): a randomised, placebo-controlled, double-blind pilot trial. Lancet Neurol. 2009, 8 (1): 48-56. 10.1016/S1474-4422(08)70263-1.CrossRefPubMed Potter JF, Robinson TG, Ford GA, Mistri A, James M, Chernova J, Jagger C: Controlling hypertension and hypotension immediately post-stroke (CHHIPS): a randomised, placebo-controlled, double-blind pilot trial. Lancet Neurol. 2009, 8 (1): 48-56. 10.1016/S1474-4422(08)70263-1.CrossRefPubMed
22.
go back to reference Mullins ME, Lev MH, Schellingerhout D, Gonzalez RG, Schaefer PW: Intracranial hemorrhage complicating acute stroke: how common is hemorrhagic stroke on initial head CT scan and how often is initial clinical diagnosis of acute stroke eventually confirmed?. AJNR Am J Neuroradiol. 2005, 26 (9): 2207-2212.PubMed Mullins ME, Lev MH, Schellingerhout D, Gonzalez RG, Schaefer PW: Intracranial hemorrhage complicating acute stroke: how common is hemorrhagic stroke on initial head CT scan and how often is initial clinical diagnosis of acute stroke eventually confirmed?. AJNR Am J Neuroradiol. 2005, 26 (9): 2207-2212.PubMed
23.
go back to reference Dubey N, Bakshi R, Wasay M, Dmochowski J: Early computed tomography hypodensity predicts hemorrhage after intravenous tissue plasminogen activator in acute ischemic stroke. J Neuroimaging. 2001, 11 (2): 184-188. 10.1111/j.1552-6569.2001.tb00031.x.CrossRefPubMed Dubey N, Bakshi R, Wasay M, Dmochowski J: Early computed tomography hypodensity predicts hemorrhage after intravenous tissue plasminogen activator in acute ischemic stroke. J Neuroimaging. 2001, 11 (2): 184-188. 10.1111/j.1552-6569.2001.tb00031.x.CrossRefPubMed
24.
go back to reference Thrift AG, Dewey HM, Macdonell RA, McNeil JJ, Donnan GA: Incidence of the major stroke subtypes: initial findings from the North East Melbourne stroke incidence study (NEMESIS). Stroke. 2001, 32 (8): 1732-1738. 10.1161/01.STR.32.8.1732.CrossRefPubMed Thrift AG, Dewey HM, Macdonell RA, McNeil JJ, Donnan GA: Incidence of the major stroke subtypes: initial findings from the North East Melbourne stroke incidence study (NEMESIS). Stroke. 2001, 32 (8): 1732-1738. 10.1161/01.STR.32.8.1732.CrossRefPubMed
25.
go back to reference Thrift AG, Donnan GA, McNeil JJ: Epidemiology of intracerebral hemorrhage. Epidemiol Rev. 1995, 17 (2): 361-381.PubMed Thrift AG, Donnan GA, McNeil JJ: Epidemiology of intracerebral hemorrhage. Epidemiol Rev. 1995, 17 (2): 361-381.PubMed
26.
go back to reference Auer RN, Sutherland GR: Primary intracerebral hemorrhage: pathophysiology. Can J Neurol Sci. 2005, 32 (Suppl 2): S3-12.PubMed Auer RN, Sutherland GR: Primary intracerebral hemorrhage: pathophysiology. Can J Neurol Sci. 2005, 32 (Suppl 2): S3-12.PubMed
27.
go back to reference Donnan GA, Fisher M, Macleod M, Davis SM: Stroke. Lancet. 2008, 371: 1612-1623. 10.1016/S0140-6736(08)60694-7.CrossRefPubMed Donnan GA, Fisher M, Macleod M, Davis SM: Stroke. Lancet. 2008, 371: 1612-1623. 10.1016/S0140-6736(08)60694-7.CrossRefPubMed
Metadata
Title
Recurrent, sequential, bilateral deep cerebellar hemorrhages: a case report
Authors
Osama SM Amin
Raz T Omer
Aso A Abdulla
Raz H Ahmed
Omed Ahmad
Soran Ahmad
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2011
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/1752-1947-5-360

Other articles of this Issue 1/2011

Journal of Medical Case Reports 1/2011 Go to the issue